Ocala Regional encouraged by DOH decisions on other trauma centers

Monday

Feb 4, 2013 at 5:48 PM

A recent decision by the Florida Department of Health to give verification status to two new trauma centers in other counties despite outside legal objections bodes well for Ocala Regional Medical Center's new trauma facility, which is facing similar legal challenges.

By Fred HiersStaff writer

A recent decision by the Florida Department of Health to give verification status to two new trauma centers in other counties despite outside legal objections bodes well for Ocala Regional Medical Center's new trauma facility, which is facing similar legal challenges.That was the conclusion of a Hospital Corporation of America lawyer representing both HCA and Ocala Regional, which is the target in a lawsuit by Munroe Regional Medical Center and Shands Jacksonville that claims the Department of Health didn't have the authority to grant Ocala Regional's trauma center provisional status to start operating.Since the Ocala trauma center opened in December, it has treated 288 trauma patients, according to the hospital.Attorney Steve Ecenia said the department's decision Friday to grant trauma centers at Blake Medical Center in Manatee County and Regional Medical Center at Bayonet Point in Pasco County their verification status — the final process in allowing a trauma center to fully operate — shows the state agency has not frozen the permitting process, despite legal action against it.The verification process typically follows the six-month to one-year provisional period during which trauma centers operate to demonstrate they can adequately provide trauma-level services.Ocala Regional is operating its Level II trauma center at a provisional status and under the authority of the Department of Health."I absolutely think that the Department of Health has acted appropriately (in its decision to verify the two trauma centers)," Ecenia said. "We are confident that Ocala Regional is moving down that (verification) path."The two trauma centers, like Ocala Regional, also faced legal challenges when Bayfront Medical Center in St. Petersburg, Tampa General Hospital, St. Joseph's Hospital in Tampa and Shands Jacksonville, argued against the department's approval process.Munroe Regional Medical Center in Ocala, Shands Hospital at the University of Florida and Shands Jacksonville Medical Center filed a December lawsuit in Leon County challenging the department's decision last year to allow a trauma center to open at Ocala Regional.The lawsuit was the latest move in a complex array of court and legislative actions challenging the state's process of permitting new trauma centers.The First District Court of Appeal in Florida decided in November 2012 that the Department of Health's rules for granting new trauma centers was outdated. That ruling came after the Florida Legislature in 2004 required the FDOH to update those rules, which had not changed since 1992.An administrative law judge found that the department rules to determine the location and need for trauma centers were invalid in September 2011.But Ecenia said that because DOH and HCA appealed the decision, the department had an obligation to process trauma applications already in the pipeline until the appeals court ruled. By the time Ocala received its DOH approval, it had already spent $6 million building its trauma facility.In a press release involving the Blake and Bayonet Point trauma center verification, the DOH addressed its authority to allow trauma centers to open their doors."During the period of appeal, the (DOH) was required to use the existing rule in effect under Florida law. Shortly after the appellate court declared the rule invalid on Nov. 30, 2012, the (DOH) notified all hospitals that had expressed interest in being a trauma center, that without a rule, the (DOH) could not approve applications and remain consistent with Florida law," the release stated.Since the appellate court's ruling, the DOH began holding public meetings to create new trauma center rules.Ecenia said Ocala Regional's application process was far enough along to allow it to start operating in December.Ocala Regional received its provisional authorization to start operating Dec. 7, 2012.Munroe argued in its lawsuit against DOH that the department was unfair because its request to provide similar trauma service was nearly identical to Ocala Regional's petition for a trauma center. The DOH sent Munroe and Jackson North Medical Center in Miami-Dade County notification on Dec. 13 that it could not approve their proposed trauma centers until the rule-making process is finished.Munroe said in its lawsuit that, "Without this court halting these actions, the (DOH's) rogue and outrageous conduct will be unchecked, the directive (by the Legislature) for a uniform and integrated state and local trauma system will continue to be disregarded and petitioners (Munroe and Shands hospitals), their staff and their patients will be irreparably injured."Ecenia said previous court rulings allow departments such as the DOH to follow their rules while being legally challenged.As for the Munroe and Shands lawsuit against DOH, Ecenia said, "I think their position is untenable."Greg Bishop is a California-based trauma center consultant who worked with Munroe and Shands on this issue. He said last month that Florida's current rules never took into account whether Ocala Regional's new trauma facility was needed, but rather focused only on the procedures to establish the facility.Bishop said many trauma centers throughout Florida often don't justify their existence. He said many are built to bring their hospitals prestige and improve their ability to compete.Trauma centers also are reimbursed at significantly higher rates by insurers than traditional emergency departments.Munroe executives did not respond for comment about the DOH decision regarding Blake and Bayonet.Meanwhile, the Department of Health also announced Friday that the seven-team member of the American College of Surgeons (ACS) Committee on Trauma will conduct an external review of Florida's current trauma system from Feb. 2-5.The department said members of the team that will provide recommendations to improve Florida's trauma system and individuals participating on the assessment team have no relationship with Florida by birth, education and training, or employment.Members of the seven person ACS COT assessment team include:· Dr. Robert J. Winchell, MD, head of the Division of Trauma and Burn Surgery at the Maine Medical Center and associate professor of surgery at the Tufts University School of Medicine.

· Jane W. Ball, RN, former director of the National Resource Center at the Children's National Medical Center (1991-2006), and former president of the National Academies of Practice.

· Dr. Samir M. Fakhry, MD, professor of surgery and chief of the Division of General Surgery at the Medical University of South Carolina, and a physician leader of the Surgical Acute and Critical Care Service Line at the university.

· Dr. Ronald F. Maio, DO, director of the Office of Human Research Compliance Review and professor of Emergency Medicine, University of Michigan.

· Drexdal Pratt, head of the Division of Health Service Regulation of the North Carolina Department of Health and Human Services, chairman of the State Medical Response Executive Committee and former commissioner of the North Carolina Governor's State Emergency Response Commission.

· Nels D. Sanddal, PhD, manager of the American College of Surgeons Trauma Systems and Verification Program, past president of the Critical Illness and Trauma Foundation in Bozeman, Montana.